15. Immune System - Autoimmune Disorders

Question 1

What are autoimmune disorders?

Answer 1

Conditions associated with an immune response against the body’s own tissues

Question 2

What is autoimmunity?

Answer 2

A breakdown of the mechanisms responsible for self-tolerance

Question 3

What are formed to fight self-antigens?

Answer 3

Autoantibodies
Cytotoxic T-cells

Question 4

What does the antibody-antigen reaction lead to?

Answer 4

Complement activation
Inflammation
Tissue damage

Question 5

Which genetic markers are linked with autoimmune diseases?

Answer 5

HLA: B27, DQ2, DR2, DR3, DR4

Question 6

What digestive tract situation is linked with autoimmune diseases?

Answer 6

Increased intestinal tract permeability (leaky gut)

Question 7

Systemic Lupus Erythematosus (SLE): definition

Answer 7

Chronic, inflammatory, autoimmune, multi-system disorder in which antibodies are formed against nuclear antigens

Question 8

Systemic Lupus Erythematosus (SLE): pathophysiology

Answer 8

B-cell activation increasing IgG levels against components of cell nuclei

Inability to remove immune complexes from tissue
Complement is activated causing inflammation
Impaired T-cell regulation

Question 9

Systemic Lupus Erythematosus (SLE): aetiology

Answer 9

• Multifactorial interaction between various genetic and environmental factors
• Higher oestrogen levels
• Low vitamin D levels
• Chronic bacterial infections common pre-diagnosis
• Viral infections e.g. EBV
• Smoking, silica dust (from concrete)
• Oral contraceptive pill, HRT, stress, UV light, pesticides can all cause flare-ups

Question 10

Systemic Lupus Erythematosus (SLE): signs and symptoms

Answer 10

Fever, malaise
Butterfly rash, photosensitivity, vasculitis (pain in fingertips), Raynaud’s syndrome (arteries in spasm)
Joint pain - peripheral (sym/asym) - hands, knees, elbows
Pleurisy, pericarditis, hypertension
Nephritis (nephrotic syndrome)
Lymphadenopathy, splenomegaly, anaemia, leukopenia

Question 11

Systemic Lupus Erythematosus (SLE): diagnostics

Answer 11

Blood tests: anti-nuclear antibodies (ANAs), anaemia, elevated ESR and complement, anti-phospholipid antibodies

Question 12

Systemic Lupus Erythematosus (SLE): allopathic treatment

Answer 12

Immunosuppressants
Corticosteroids
Sunscreen*
NSAIDs

*This has a consquence for Vit D deficiency

Question 13

Rheumatoid Arthritis: definition

Answer 13

Autoimmune, chronic, systemic inflammation of the synovium
Potentially affects all organs (except brain)

Question 14

Rheumatoid Arthritis: pathophysiology

Answer 14

RF (present in around 80% of sufferers) is an auto-antibody which is directed against a portion of IgG
Resultant immune complexes activate complement proteins leading to inflammation

Question 15

Rheumatoid Arthritis: aetiology

Answer 15

Genetic markers - HLA-DR4 and DR1
Infectious agents e.g. rubella, EBV
Abnormal intestinal permeability, small intestinal bacterial overgrowth (SIBO)
Smoking

Question 16

Rheumatoid Arthritis: signs and symptoms

Answer 16

• Symmetrical/bilateral arthritis of small joints (hands and feet mostly)
• Gradually spreads to more proximal structures
• Progressive morning stiffness (> 1 hr)
• Deformity of joints e.g. swan neck, ulnar deviation
• Subcutaneous nodules around fingers/elbows
• General malaise and fatigue
• C1/C2 subluxation and compression of the spinal cord leading to paralysis and neurological complications
• Kidney / pulmonary problems

Question 17

Rheumatoid Arthritis: allopathic treatment

Answer 17

Anti-inflammatories and immunosuppressants
Immunomodulators - methotrexate (hard drug, best avoided)
Surgery

Question 18

Rheumatoid Arthritis: epidemiology

Answer 18

Affects 1% of people worldwide; greater in women
Peak occurrence - 30-50 yrs old

Question 19

Ankylosing Spondylitis: definition

Answer 19

Systemic autoimmune disease associated with chronic inflammation of the spine and sacroiliac joints
Often leads to spinal fusion and stiffness

Question 20

Ankylosing Spondylitis: aetiology

Answer 20

Strong genetic association with HLA-B27 (present in 95% of patients)
Links with inflammatory bowel diseases and leaky gut
Urogenital or intestinal infections such as salmonella and shigella can cross react with HLA-B27

Question 21

Ankylosing Spondylitis: signs and symptoms

Answer 21

Typically begins with sacroiliac and lower lumbar spine pain, before progressing up spine
Associated with worsening morning stiffness
Lower back pain improves with activity
Lumbar lordosis flattens and patients often become kyphotic
Hip and heel pain common
20% suffer acute iritis* (eye infection)
Systemic symptoms - fever, fatigue, malaise

*linked to HLA B27

Question 22

Ankylosing Spondylitis: diagnostics

Answer 22

Bloods - elevated inflammatory markers (CRP, ESR), positive for HLA-B27
X-ray, MRI - to reveal characteristic bamboo spine

Question 23

Ankylosing Spondylitis: allopathic treatment

Answer 23

Anti-inflammatories
(NSAIDs and steroids)
Surgery in later stages

Question 24

Ankylosing Spondylitis: epidemiology

Answer 24

• Age of onset typically 15-30 yrs old
• More common in males

Question 25

Hashimoto's Thyroiditis: definition

Answer 25

Autoimmune condition causing hypothyroidism

Question 26

Hashimoto's Thyroiditis: pathophysiology

Answer 26

Thyroid gland gradually destroyed by a variety of cell- and antibody-mediated immune processes Auto-antibodies develop that react with thyroglobulin and thyroid cells preventing the synthesis of thyroid hormones Leading to low thyroid hormones - T4 and T3

Question 27

Hashimoto's Thyroiditis: signs and symptoms

Answer 27

Tiredness, malaise, weight gain, cold intolerance, constipation, depression Slow cognition, poor memory, low libido, deep voice, menstrual changes, muscle aches, arthralgia (joint pain) Goitre, dry, brittle skin, thin hair, loss of eyebrows Myxoedema (swelling often around eyes - deposition of polysaccharides which attract water)

Question 28

Hashimoto's Thyroiditis: diagnostics

Answer 28

Physical - slow tendon reflexes, bradycardia Blood tests - high TSH, low thyroid hormones Barnes temperature test - below 36.6C may indicate hypothyroidism

Question 29

Hashimoto's Thyroiditis: allopathic treatment

Answer 29

Levothyroxine - thyroid hormone replacement

Question 30

Graves' Disease: definition

Answer 30

Autoimmune condition causing hyperthyroidism

Question 31

Graves' Disease: pathophysiology

Answer 31

Increased IgG antibodies bind to TSH receptors and stimulate production of thyroid hormones

Question 32

Graves' Disease: aetiology

Answer 32

Excessive iodine supplementation Tumour - hypothalamic, pituitary

Question 33

Graves' Disease: signs and symptoms

Answer 33

Nervousness, irritability, hyperactivity, unexplained weight loss, heat sensitivity, increased swelling Insomnia, palpitations, muscle weakness, frequent bowel and bladder movements, diarrhoea, fatigue (only symptom similar to hypothyroidism) Goitre (only sign similar to hypothyroidism), exophthalmos (bulging eyes), tachycardia, tremor, brisk tendon reflexes, lid lag

Question 34

Graves' Disease: allopathic treatment

Answer 34

Carbimazole (to block thyroid activity) Radioactive iodine (to destroy part of the thyroid gland*) Beta-blockers (to manage tachycardia), surgery | *Can result in hypothyroidism

Question 35

What can be used to confirm increased intestinal permeability (leaky gut) ? | **Not on slides

Answer 35

Comprehensive stool analysis can show markers such as zonulin

Question 36

What is zonulin ? | Not on slides

Answer 36

A protein that plays a role in regulating the permeability of the intestinal mucosal barrier Is is released in response to gluten or certain bacteria

Question 37

Systemic Lupus Erythematosus (SLE): natural treatment

Answer 37

* Anti-inflammatory diet * Supplements: vitamin D3, antioxidants, alpha lipoic acid, EFAs. * Herbs, acupuncture and homeopathy. * Manual therapy for joint pain. * Stress reduction, e.g. meditation, breathing exercises, etc.

Question 38

Rheumatoid Arthritis: natural treatment

Answer 38

* Nutrition: anti-inflammatory and reducing intestinal permeability: increase antioxidants, * Mediterranean diet / increase omega-3, Vit D3 * Herbs for pain and inflammation and immune modulation: Turmeric, Boswellia, Devil’s Claw. * Homeopathy (e.g. Rhus tox) and acupuncture.

Question 39

Ankylosing Spondylitis: natural treatment

Answer 39

Nutrition (remove pathogenic organisms / elimination diet / increase vitamin D3 and antioxidants) Herbs (antiinflammatory) Homeopathy; acupuncture Manual therapies to help prevent kyphosis